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Tesofensine was originawwy investigated for de treatment of Awzheimer's disease and Parkinson's disease,[3] and was subseqwentwy dropped from devewopment for dese appwications after earwy triaw resuwts showed wimited efficacy for treatment of dese diseases.[4][5] However, weight woss was consistentwy reported as an adverse event in de originaw studies, especiawwy in overweight or obese patients.[6] Therefore, it was decided to pursue devewopment of tesofensine for de treatment of obesity.

Tesofensine primariwy acts as an appetite suppressant, but possibwy awso acts by increasing resting energy expenditure.[7]Phase 2 triaws for de treatment of obesity have been successfuwwy compweted.

Tesofensine has a wong hawf-wife of about 9 days (220 h)[3] "and is mainwy metabowized by cytochrome P4503A4 (CYP3A4) to its desawkyw metabowite M1" NS2360.[8][9] NS2360 is de onwy metabowite detectabwe in human pwasma.

NS2330 is mainwy metabowized by cytochrome P450 3A4 (CYP3A4) into .

It has a wonger hawf-wife dan tesofensine, i.e. approximatewy 16 days (374 h) in humans, and has an exposure of 31–34% of de parent compound at steady state. In vivo data indicate dat NS2360 is responsibwe for approximatewy 6% of de activity of tesofensine. As in animaws, de kidney appears to pway onwy a minor rowe in de cwearance of tesofensine in humans (about 15–20%).

Originawwy it had been reported dat Tesofensine has IC50 of 8.0, 3.2 and 11.0nM at de DAT, NAT and 5HTT.[10] More recentwy, dough, de fowwowing data was submitted: IC50 (nM) NE 1.7, SER 11, DA 65.[[11] cited in [12]] The revised IC50's wouwd adeqwatewy expwain de wack of efficacy in treating Parkinson's disease, i.e. insufficient DRI potency rewative to de SERT and de NET. This couwd awso hewp account for why Tesofensine is not rewiabwy sewf-administered by human stimuwant abusers[13] since it has been bewieved to be de case dat DAT inhibition is necessary for dis and not NET inhibition, uh-hah-hah-hah.[14][15]

Phase 2b triaw (TIPO-1) resuwts reported in The Lancet[17] showed wevews of weight woss over a 6-monf period dat were significantwy greater dan dose achieved wif any currentwy avaiwabwe drugs. Patients wost an average of 12.8 kg on de 1 mg dose, 11.3 kg on de 0.5 mg dose and 6.7 kg on de 0.25 mg dose, compared wif a 2.2 kg woss in de pwacebo group.

Aww participants were instructed to fowwow a diet wif a 300 kcaw deficit and to increase deir physicaw activity graduawwy to 30–60 minutes of exercise per day. The pwacebo-subtracted mean weight wosses were 4.5%, 9.2% and 10.6% in de 0.25 mg, 0.5 mg and 1 mg dose groups, respectivewy. This is approximatewy twice de weight woss produced by medications currentwy approved by de US Food and Drug Administration (FDA) for de treatment of obesity.

NeuroSearch has awso reported interim resuwts[7] from a 48-week, open-wabew, extension triaw (TIPO-4) in which 140 patients who compweted de 24-week phase 2b triaw (TIPO-1) were re-enrowwed after an average of 3 monds’ wash-out. Aww were initiawwy treated wif 0.5 mg tesofensine once daiwy but up-titration to 1.0 mg once daiwy was awwowed in de first 24 weeks of de extension study. At dis time point, aww subjects were continued on de 0.5 mg dose for an additionaw 24 weeks. The 24-week interim resuwts for dose who were previouswy treated wif tesofensine 0.5 mg in TIPO-1 showed a totaw mean weight woss of between 13 kg and 14 kg over 48 weeks of treatment. Furdermore, TIPO-4 confirmed de TIPO-1 resuwts since dose patients who were previouswy treated wif pwacebo wost approximatewy 9 kg in de first 24 weeks of de TIPO-4 study.

In generaw, de safety profiwe of tesofensine is simiwar to currentwy approved medications for de treatment of obesity. The most commonwy reported side effects in de obese popuwation were dry mouf, headache, nausea, insomnia, diarrhoea and constipation, uh-hah-hah-hah. A dose-dependent pattern was observed for dry mouf and insomnia. The overaww widdrawaw rate due to adverse events in cwinicaw triaws in de obese popuwation was 13% wif tesofensine and 6% wif pwacebo. Bwood pressure and heart rate increases wif de derapeuticawwy rewevant doses of tesofensine (0.25 mg and 0.5 mg) were 1–3 mmHg and up to 8 bpm, respectivewy.[7][17]